Rise & Shine Preschool All Saints Lutheran Church 5501 148th Ave NE, Bellevue, WA 98007
Preschool Summer Camp 2018 4’s & 5’s (Must be 4 years of age by January 2018)
Registration Form Rise & Shine Preschool’s Summer Camp offers families a safe and fantastic environment where your kids can learn and play. Our program features: • • •
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Low student to teacher ratio Fun summer theme every week Fun crafts and delicious snacks every day!
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Onsite fieldtrip and cooking once a week Weekly (5 day) enrollment from 9:15am-12:45pm
Week 1: June 18th – 22nd Theme: Start your engines! Onsite fieldtrip: Dizzy Bus
Week 2: June 25th – 29th Theme: The Animal Kingdom Onsite fieldtrip: Animal Encounters
Week 3: July 9th – 13th Theme: The Hungry Caterpillar Onsite fieldtrip: Bug Safari
Week 4: July 16th – 20th Theme: Looney Onsite fieldtrip: Daffy Dave Show
Payment Information: Summer Camp is one 5-day class, per week, available on a first come, first serve basis. There is a one-time fee of $25 due with registration. There are no refunds for summer camp tuition or fees paid. Credit card payments will be assessed a 4% processing fee ($26 registration and $182 weekly tuition). Tuition must be paid in full by June 8th. $25 Registration fee (due with registration form) $175 Weekly fee Registration Fee
$25
Paid by ____________ Date ___________
Please check the week(s) your child will attend Week 1 _____ Week 2 _____ Week 3 _____ Week 4 _____ All Four Weeks _____ Total Tuition: $_________ Paid by ____________ Check# ____________ Date ____________ Child’s Name __________________________________________ Birthday _______________ Boy or Girl ______ Parent’s Names (Dad) _________________________________ (Mom) ___________________________________ Address _____________________________________________________________________________________________ City___________________________________________ State ________________ Zip ____________________ Phone Numbers (Dad) _________________________________ (Mom) ___________________________________ Email(s) ____________________________________________________________________________________________ Please Complete Reverse Side
Rise & Shine Preschool All Saints Lutheran Church 5501 148th Ave NE, Bellevue, WA 98007
Emergency/Contact Information 2018 Child’s Name _________________________________________________ Date of Birth _______________________ Father’s Phone ________________________________ Mother’s Phone __________________________________ Allergies ____________________________________________________________________________________________ Medical Conditions ________________________________________________________________________________ Medications ________________________________________________________________________________________ Doctor’s Name ________________________________ Phone _______________________________________ Permission for medical treatment: I, _______________________________________, the parent or guardian hereby give permission that my child, ________________________________, may be given emergency treatment to include first aid and CPR by a qualified staff member of All Saints Lutheran Church, I also give permission for my child to be transported by ambulance, treated by aid car personnel, and/or transported to an emergency center/hospital for treatment. In the event that I cannot be contacted I further authorize and consent to the medical, surgical, and hospital care, treatment, and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s health. I waive my right to informed consent for such treatment. I realize that the school and church will not assume responsibility for payment of medical fees or expenses incurred. Signed __________________________________________________ Date _______________________________ Emergency Contacts if Parents are unavailable Name ___________________________________________________ Phone _____________________________ Relationship ___________________________________________ Name ___________________________________________________ Phone _____________________________ Relationship ___________________________________________ Name ___________________________________________________ Phone _____________________________ Relationship ___________________________________________
Rise & Shine Preschool All Saints Lutheran Church 5501 148th Ave NE, Bellevue, WA 98007 PARENT PERMISSION AND WAIVER FORM FOR FIELD TRIP I/We, the parents/guardians of the student named below, understand the nature of the field trip planned for All Saints Lutheran Church on (Date) __________________ PERMISSION We grant permission for our son/daughter to participate. We understand that adequate and appropriate supervision will be provided. In the event of an injury requiring medical attention, I hereby grant permission to the supervising teacher(s) or staff (including volunteers) to attend to my son/daughter. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising teacher(s) or staff (including volunteers) to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on the trip and I cannot be located. WAIVER We recognize, however, that unanticipated situations and problems can arise on any trip, school-sponsored or otherwise, which situations or problems are not reasonably within the control of the supervising teacher(s) or staff (including volunteers). We further agree to release and hold harmless All Saints Lutheran Church, its agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense, (including attorneys’ fees and costs) arising from such activities, including any accident or injury to the student and the costs of medical services, or any cause beyond the control of ASL, including, but not limited to, natural disasters, civil disturbances, acts of terrorism, and wars. Student Name (Please Print): ________________________________________________________ Parent or Guardian Signature: __________________________ Date: ______________________ Home Phone: ______________ Work Phone: _______________ Cell Phone: ________________
Rise & Shine Preschool All Saints Lutheran Church 5501 148th Ave NE, Bellevue, WA 98007
Rise & Shine Summer Camp Information •
Doors open at 9:00am and Pickup is 12:45pm
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Pick up ends at 1:00pm. Picking up past 1:00pm will be assessed a late fee.
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Typical Daily Schedule: 9:00-10:00 Opening/Open play (possibly outside) 10:00-10:15 Morning meeting 10:15-10:45 Bathroom and snack 10:45-12:00 Organized activities, games, crafts, outdoor time (Wednesday is fieldtrip and Thursday is cooking) o 12:00-12:30 Bathroom and lunch o 12:30-12:45 Free play until dismissal o o o o
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Snack is provided. A schedule of snacks will be posted on the bulletin board.
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Please send your child with a lunch. We do not heat or cook lunch items, so please send a lunch that is ready to eat.
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Please apply sunscreen, if weather permits, before camp.
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Please dress your child in appropriate clothing for activities and weather (i.e. tennis shoes, jackets, etc.).
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Your child is required to be signed in and out
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Any other questions please call or email me
Sincerely,
Paix Irigon Preschool Director (425) 691-8325
[email protected]
